Quality Improvement Analyst

WellCare Health Plans, Inc. (NYSE:WCG) a Fortune 1000 company, is the nation?s leading provider of government health insurance products dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children?s Health Insurance Programs, Medicare Prescription Drug Plans and others. Founded in 1985, our team of 2,500 associates and over 20,000 physician partners serve 2.0 million members across the U. S. Our company headquarters are based in Tampa, FL. For more information about WellCare, please visit the Company?s website at www.wellcare.com.

 

We are looking to add a Quality Improvement Analyst to our Health Services team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be a part of a dynamic, growing organization, then this may be the opportunity for you.

 

Job Summary: 

Plan, develop, and execute the IL Market Quality Assurance Program relative to goals and objectives as identified by corporate, local, state and federal entities.

 

Essential Functions: Plan, organize and coordinate the Quality Assurance program initiatives in order to achieve measurable state, local and federal objectives. Develop and execute the Quality Program Description, Work Plan and Health Education PlanSupport corporate initiatives through participation on internal and external committees and projectsStatistical analysis of utilization, disease prevention and health promotion data and subsequent intervention implementationResearch, assessment and reporting of Quality of Care and Quality of service issuesEvaluate and recommend changes to medical service functions through incorporation of best practices, while maintaining compliance with the company?s mission statement, philosophies, objectives and policies.Attend marketing, coalition, Political and charitable events in order to maintain appropriate corporate and governmental relationships.Identify cost effective external resources for enhancement of HEDIS, provider and customer satisfaction surveys.  Coordinate audit and accreditation processes specifically NCQA, and/or External Review OrganizationsCoordinate Annual reports, Provider and Enrollee surveysInsure that all quality P&P's are BBA compliantParticipate in Local, Regional and National Clinical Quality Improvement Committees as appropriate.  Assist with development of Health Promotion and Disease Prevention educational seminarsAnalyze HEDIS clinical and statistical data to determine areas of focus relative to compliance, interventions, and overall disease management.Maintenance of relationships with vendors, facilities and providers

 

 

Supervision Received/Exercised: Receive supervision from the Director of Utilization/Quality ManagementMeets biweekly with Director of Utilization/Quality Management

 

 

  Scope of Decisions: Maintain relationships with internal and external Staff, vendors, facilities, State, local and Federal agencies

 

Knowledge, Skills, Abilities Required:





Education/Experience:Bachelor of Science degree in Nursing, Active or Health Related FieldState Registered Nursing License preferred3-5 years of clinical, project management, and/or business experience preferredKnowledge of local, state and federal regulation and accreditation standards a plusFamiliarity with the community and socioeconomic challenges faced by the underserved populationStrong interpersonal, oral, and written communication skills Excellent project management and presentation skillsPersonal and professional values that mirror the corporation?s philosophies and mission statementAbility to achieve results within a fast paced and fluid business environment

 

Communications and Numeric Skills: Exercises sound judgment while communicating with health care professionals and membersCommunicates all issues in a reserved, respectful and nonjudgmental styleCreates concise, professional business correspondenceUtilizes basic math calculations for spreadsheets, supplies and reporting functionalities

 

Computer Skills: Possesses basic knowledge of the functioning of the following software packages:Microsoft Word, ExcelLotus NotesAccessPower Point

 

Physical Demands: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear.  The employee is occasionally required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl.  The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision, and ability to adjust focus.

 

Working Conditions:The work environment is a climate controlled office environment during normal business hours. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.